Persistent postpartum haemorrhage after failed arterial ligation: value of pelvic embolisation

• Published in: European radiology Vol. 20; no. 7; pp. 1777 - 1785
• Main Authors: Fargeaudou, Yann, Morel, Olivier, Soyer, Philippe, Gayat, Etienne, Sirol, Marc, Boudiaf, Mourad, Dahan, Henri, Barranger, Emmanuel, Mebazaa, Alexandre, le Dref, Olivier
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.07.2010; Springer Nature B.V
• Subjects: Adult; Childbirth & labor; Diagnostic Radiology; Embolization; Embolization, Therapeutic; Female; Hemorrhage; Humans; Hysterectomy; Iliac Artery - surgery; Imaging; Internal Medicine; Interventional; Interventional Radiology; Ischemia; Ligation; Medicine; Medicine & Public Health; Neuroradiology; Postoperative Complications; Postpartum Hemorrhage - therapy; Pregnancy; Radiology; Retrospective Studies; Review boards; Ultrasound; Vagina; Veins & arteries; Women; France; Paris France; Postpartum haemorrhage; Arterial ligation; Abnormal placentation; Internal iliac artery; Percutaneous transcatheter arterial embolisation; Pelvic embolisation
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-010-1713-y

Objectives To evaluate the role and efficacy of pelvic embolisation in the treatment of persistent postpartum haemorrhage after failed arterial ligation and to identify the complications of this procedure in this specific population. Methods The clinical files and angiographic examinations of 12 consecutive women (mean age 32 years) who were treated with pelvic embolisation because of persistent, severe postpartum haemorrhage after failed arterial ligation were reviewed. Results Angiography revealed that persistent bleeding was due to incomplete arterial ligation ( n  = 4) or the presence of newly developed anastomotic routes ( n  = 8). In 11 women, pelvic embolisation stopped the bleeding. Hysterectomy was needed in one woman with retained placenta. Two complications due to pelvic embolisation, including leg ischaemia and transient sciatic nerve ischaemia, were identified, both after internal iliac artery ligation. Conclusions In women with persistent postpartum haemorrhage after failed arterial ligation, pelvic embolisation is an effective treatment in most cases. However, embolisation of the anastomotic routes that contribute to persistent bleeding may result in ischaemic complications. These potential complications reaffirm that arterial ligation should not be the favoured option for postpartum haemorrhage and that special care must be given during pelvic embolisation after failed arterial ligation.